I think it is important to voice a scientific view that differs markedly from that of Simon Baron-Cohen of the Cambridge Autism Research Unit who has, according to recent media reports, been calling for a debate on pre-natal screening for autism.

Several aspects need to be taken into account in this important matter: Is the issue of elevated testosterone in autism valid? Is elevated testosterone specific to autism? What are the consequences for individuals with autism and future families contemplating pregnancy, particularly in light of recent media coverage depicting autism as a serious debilitating condition? What other issues in autism are being overlooked with the endorsement of this speculative hypothesis?

First of all, it is by no mean proven that an excess of testosterone is implicated in autism. Whilst the recent study from Auyeung et al. conducted on 235 non-autistic children suggests that there is a relationship between higher levels of testosterone and higher autism trait quotients, it should be highlighted that the quotient of autism that was measured in this study relied on the use of two parental questionnaires (the Childhood Autism Spectrum Test and the Child Autism Spectrum Quotient) and not gold standard psychometric measurements of autism, which are based on observations made by trained psychologists and paediatricians. The study seemed to rely on earlier research that suggested a link between autism and high levels of testosterone, but these were equally controversial. One piece of research, also conducted by Simon Baron-Cohen, suggested that individuals with high functioning autism have a low empathy quotient, and this was attributed to excess maleness, i.e. testosterone. However, the empathy test used for these studies relied essentially on measuring empathy within a social context, which, not surprisingly people with Asperger’s are poor at, as they frequently do not have full social understanding irrespective of their empathic abilities. A second type of research, also led by Simon Baron-Cohen suggested that the ratio between the length of the second and forth digit (2D:4D) in people with autism is indicative of an abnormally high level of embryonic exposure to testosterone. These abnormalities in 2D:4D ratios have not been replicated by others, and are, at best, very indirect evidence of testosterone secretion. In fact, other genetic factors are also known to influence this ratio.

Whilst some individuals with autism may indeed have abnormal steroid metabolism, and present with excessive androgen levels, as measured in blood and urine samples, these abnormal findings appear to be by no means representative of the autistic children seen today, especially children who have experienced regressive autism, characterised by a loss of already acquired skills in the areas of communication, socialisation and behaviour. Many of these children present with a failure to thrive physically, and are often under weight and have delayed maturation, which is hardly compatible with excess testosterone.

It should be noted that testosterone is implicated in a wide variety of biological and behavioural processes. It is required for normal development, sexual maturation and sexual activity, and in many aspects of human behaviour, in addition to being potentially neuro-protective. A study, also from Cambridge University, Published in 2008, in the ‘Proceedings of the National Academy of Sciences’, showed that males working as stock traders had higher testosterone levels. Traders with elevated testosterone were found to be more confident and have a risk-taking appetite, which is hardly compatible with autistic traits. Other studies have found that elevated testosterone increases the secretion of the non-amyloidogenic APP fragment, and decreases the secretion of Amyloid beta peptides suggesting that testosterone supplementation in elderly men may be protective in the treatment of Alzheimer Disease. It therefore seems that a pre-natal test for testosterone in itself is insufficiently specific and sensitive as a method of predicting the likelihood of developing autism.

It is of great concern that studies on testosterone and autism are being misinterpreted, leading to the use of therapies aimed at disturbing steroid hormone production in individuals with autism. Currently, many autistic children may be being treated, without proof of safety and scientific and medical evidence of benefit, with a view to reducing their hormonal secretion of testosterone (Lupron Therapy, Spironolactone). The rationale behind advocating these therapies appears to be based on a misunderstanding of autistic behaviours and without systematic laboratory evidence of abnormal testosterone levels.

It is premature and ethically wrong to call for a debate on pre-natal screening with the potential for pregnancy termination when there is not even a sound scientific basis for the autism/testosterone theory. Autistic individuals would be better served by being assisted in reaching their fullest health and well being. The issues of autism that urgently need addressing today concern: A) a plausible explanation for the 7-10 fold rise in autism rates seen in the last 10-15 years; B) a better understanding of the novel gut and immune pathologies identified in autism; and C) the interplay of environmental and genetic factors that are implicated in regressive autism. It is also essential that more effort is made to provide better education services and improved support for families.

Simon Baron-Cohen’s latest effort is a distraction from the real issues.

Who wrote this stuff? Testosterone is not the right answer. I can tell that by the term "maleness" that it was written by a women. My mother did this to me when she thought I had autism. When they found out that I did not, it was too late. My testosterone levels were knocked out. I have to go thorugh testosterone replacement theropy now. Just because your child is testostosterone laden does not mean you have to lower the levels of their testosterone. They may find their way into athletics when they grow up. That is all.

I have twins (fraternal), one has high-functioning autism and ADHD the other is a very kind, socially aware little boy ... interestingly the mother has PCOS and so is likely to have higher levels of testosterone ...

Lorene, I think you have presented an excellent argument here. I hope you will step up and kepp confronting Baron-Cohen and his theories they appear to be designed to "kick the ball into the long grass".

I do not have the space to develop my arguments here but I don’t think the link between testosterone and mercury is valid. I know there is a lot of interest for mercury in autism, particularly in the USA, but the issues in autism are much more complex than this unfortunately. We have only a very small proportion of children in our group that appear to have significantly abnormal levels of mercury. The situation might be different in the USA though, but I am not convinced either.

Simon Baron Cohen changes his views publicly to fit with the most popular views of the time, like a politician does. He was not so opposed to Geier and Geier last year but now they have bad press, he is. Same is with the ante-natal screen, he backtracked in an article that followed a report in the UK Guardian newspaper last January, arguing that there has been some misrepresentation by the media of his views, but he had been heard asking for a debate on that issue on the radio just a few days before.

When Simon Baron Cohen kept presenting data on people with Asperger / High functioning autism, generalising his findings to the whole spectrum, and also discussing normal children with ASD traits, I kept asking him, what about the 60% of kids who present with regressive autism? I did not have much of an answer, I am afraid. If he knows about them, he has repressed the data, as he did with the Cambridgeshire rate of autism found to be as high as 1 in 49. But my guess is that he is not really interested about these kids just now, because he has not yet seen how he could get advantage of that knowledge, after all, aren't these kids a real proof there is something wrong with our environment and the genetic only play parts of it, unlike what his theories of autism imply? Also would he really want to risk compromising his chances of getting funding by addressing this prickly problem?

On the front of today's Chicago Trib is the following story regarding autism, testosterone, and lupron.http://www.chicagotribune.com/health/chi-autism-lupron-may21,0,242705.story
It sounds as if the 2 gentlemen advocating lupron are due to attend the Autism One conference in Chicago this week. I'm not informed enough on lupron to make an opinion, but I can say the article portrayed these 2 guys as fringe scientists with nothing to back up their claims. Read the article for yourselves, but my conclusion is if the authors of this Chicago trib article conclude these guys are fringe scientists, associate them with Jenny McCarthy, and use phrases such as "...allegedly dramatic results" that's enough for me to look further into the treatment.

Simon Baron-Cohen seems to be level headed on 1 issue, and that is in regards to Dr. Mark Geier and Dr. Mayer Eisenstein. Who want to use Lupron to treat autistic children.

"Simon Baron-Cohen, a professor of developmental psychopathology at the University of Cambridge in England and director of the Autism Research Center in Cambridge, said it is irresponsible to treat autistic children with Lupron.

"The idea of using it with vulnerable children with autism, who do not have a life-threatening disease and pose no danger to anyone, without a careful trial to determine the unwanted side effects or indeed any benefits, fills me with horror," he said."

What I don't understand is why these 2 doctors who are using Lupron, a drug used to chemically castrate sex offenders in prison, are being invited and allowed to speak at the upcoming Autism One conference at the Westin O'Hare in Rosemont with the key note speaker being Jenny McCarthy. I wouldn't want to be in the same building as these 2 doctors who are using such an absolutely appalling drug on young children with no solid evidence or even success.

"Isn't the testosterone link more along the lines that testosterone is synergistic with mercury, and thus babies with higher testosterone are more at risk for the devastating effects of mercury exposure?"

Let's not move away from this basic simple fact. Boys have higher levels and the girls that present often have unusually high levels for females. The Lupron protocol is often used to lower testosterone levels to help with mercury chelation and lower porphryn levels. If 4 out of 5 affected are male and the one female usually presents with high levels (lab confirmed) why would we not look at testosterone and its relationship to toxins/metals.

"especially children who have experienced regressive autism, characterised by a loss of already acquired skills in the areas of communication, socialisation and behaviour. Many of these children present with a failure to thrive physically, and are often under weight and have delayed maturation, which is hardly compatible with excess testosterone."

I know children who do not physically present with high levels based on your description above and have lab confirmation of high levels regardless. Testosterone is a player in this epidemic in its relationship to early childhood toxic exposure. Let's move away from pre-natal testing and let's concentrate on early childhood exposure.

I do not think there is any reality at the moment for the development of an ante-natal screen for autism, certainly not if this is based on testosterone. That is not the major problem with this theory. The major problem is that it is a twisted hypothesis that arises from weak psychological evaluations of maleness, autism, broad autism phenotype in order to explain the current rise in autism rate. The second problem is that there is a very high risk for people to misinterpret some impulsive/ aggressive behaviours seen in autism as an indication of excessive testosterone. This leads to total misunderstanding of behaviour (for example not addressing why the person might be aggressive in the first place) and totally inappropriate management with Lupron for example. The third problem is that these developments tend to be embraced by mainstream academics who actually do not know about autism in concrete terms, this will in turn influence further research funding at the expense of much more relevant research.

Dear Dr. Amet, Thankyou , thankyou, Your points are absolutely right on the dot in so many ways. I am sure I am correct in saying that many of us have looked askance at Baren-Cohens ideas but we may lack the scientific expertise to refute them in the way you have done. I would say that right from the beginning Mr Baron Cohen has served as a distraction from the real science that autistic children so desperately need. He serves so well the interests of those who wish us to be deluded into thinking that autism is genetic. How can it be that someone who wishes to be thought so terribly clever, has nothing to say about all the other science that points to other causes of autism? How is it that he has nothing to say about all the symptoms of autism that cannot be explained with his ideas ? If his theory doesnt fit the reality on the ground, what use is it? Even a totally non scientific person would possess the farmboy logic to say, Why do you so much as whisper the idea of prenatal testing on such flimsy proof and no concrete, proven method.? Put his photo on a black wall along with all the others who have delayed us in finding the answers we need.
By the way, can his theories explain to us why autism is now surging very suddenly in India, starting about 5 years back. We have moved, in a few brief years from few educated Indians knowing what autism is to every fourth person knowing someone who has an autistic child. Strange are the ways of testosterone.

Ahhhhh come on, they can not tell - because they have no scientific evidence, and if they do- it is Speck-U-lation, but by the people that count.

Why, even the doctors can't tell if their own patients- actually born- 2 or 3 years old, or 12 years old is autistic, let alone in the womb. Besides autism is a brian injury-so when did and why did the brain injury occur.

Isn't the testosterone link more along the lines that testosterone is synergistic with mercury, and thus babies with higher testosterone are more at risk for the devastating effects of mercury exposure? In that case, a GenRescue/TACA type of vaccine schedule, and/or not exposing the fetus to mercury via maternal fish consumption, would be more effective than some sort of screening process. There's no way to predict which babies with high testosterone will subsequently have such an environmental exposure.

A large percentage of babies who are aborted because of possible defects or disabilities have been found to be normal - of course by then it's too late to piece them back together or undo the saline burn.

All this screening will do is lead to more babies being unnecessarily aborted by frightened parents. When are people going to recognize that the harder we try to escape discomfort & suffering the more we create?